BMJ  2005;331:778 (1 October), doi:10.1136/bmj.331.7519.778

Letter

A theme issue by, for, and about Africa

Results from Ugandan programme preventing maternal transmission of HIV

EDITOR—Since the efficacy of antiretroviral drugs in preventing HIV transmission from mother to child was first shown, much effort has been devoted in many countries in Africa to implement sustainable regimens.^1-4 To identify potential reasons affecting uptake we evaluated the five year performance of a programme at St Francis Hospital Nsambya in Kampala, Uganda. The programme included voluntary counselling and confidential HIV testing for pregnant women and administration of antiretroviral prophylaxis in the peripartum period (zidovudine or nevirapine) for HIV positive women.

Overall 24 133 women received counselling, 76% (18 384) agreed to be tested, and 2011 (10.9%) were HIV positive; 1341 (66.7% of the HIV positive women) were enrolled in the programme and received antiretroviral drugs.

Acceptance of the test increased from 72.7% (9103/12 524) in 2000-2 to 79.9% (9281/11 609) in 2003-4, when a drug access programme became available in the hospital.

Acceptance of the test and enrolment in the programme were lower in married or cohabitating women (test acceptance rate 72.9% (7735/10 605)) than single women (78% (860/1106)), indicating that the fear of being identified as HIV positive in the family is still a strong limiting factor and that men could have an important role. Acceptance of the test was lower in women belonging to the local tribe in Kampala (Baganda), probably because of fear of being recognised by hospital health workers.

Higher education was associated with a lower prevalence of HIV and a higher enrolment in the programme, confirming that education can have a key role not only in protecting against HIV but also in allowing HIV positive people to benefit from existing measures against the spread of HIV.

giuliano{at}iss.it
Istituto Superiore di Sanità, Viale Regina Elena, 299 00161 Rome, Italy

Istituto Superiore di Sanità, Viale Regina Elena, 299 00161 Rome, Italy

St Frances Hospital Nsambya, PO Box 7146, Kampala, Uganda

PMTCT programme Ministry of Health of Uganda, PO Box 7272, Kampala, Uganda

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Competing interests: None declared.

References

1. Stringer EM, Sinkala M, Stringer JSA, Mzyece E, Makuka I, Goldenberg RL, et al. Prevention of mother-to-child transmission of HIV in Africa: successes and challenges in scaling-up a nevirapine-based program in Lusaka, Zambia. AIDS 2003;17: 1377-82.[CrossRef][Web of Science][Medline]
2. Temmerman M, Quaghebeur A, Mwanyumba F, Mandaliya K. Mother-to-child transmission in resource poor settings: how to improve coverage? AIDS 2003;17: 1239-42.[CrossRef][Web of Science][Medline]
3. Perez F, Orne-Gliemann J, Mukotekwa T, Miller A, Glenshaw M, Mahomva A, et al. Prevention of mother to child transmission of HIV: evaluation of a pilot programme in a district hospital in rural Zimbabwe. BMJ 2004;329: 1147-50.[Abstract/Free Full Text]
4. Painter TM, Diaby KL, Matia DM, Lin LS, Sibailly TS, Kouassi MK, et al. Women's reasons for not participating in follow up visits before starting short course antiretroviral prophylaxis for prevention of mother to child transmission of HIV: qualitative interview study. BMJ 2004;329: 543.[Abstract/Free Full Text]

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